Raynaudís Disease


 

 

 

 

 

 

 

 

 

 

 

 

 

         

What Is Raynaudís Disease?

Raynaudís disease is a condition that affects the blood supply to the fingers, toes and occasionally the ears and nose. During a Raynaudís attack, or episode, the blood vessels constrict (narrow) and the blood supply to these areas is reduced. This results in several skin color changes which are often accompanied by a throbbing or burning sensation, cold, and numbness. The exact cause of Raynaudís disease remains unknown. However, current research is coming closer to determining a probable cause.

What Are The Symptoms Of Raynaudís Disease?

During a typical Raynaudís attack the affected area may first become white (pallor) as the blood supply is reduced, then blue (cyanosis) as the oxygen supply to the area is depleted, followed by bright red (rubor) as the blood returns to the area (reactive hyperemia). Raynaudís disease, by definition, involves three color changes. However, they do not always occur in the same order for all people all of the time nor do all three changes always occur in a given attack.

What Causes A Raynaudís Attack?

Raynaudís episodes can be triggered by cold, either by touching cold objects or by being in a cold environment. Emotions such as stress and anxiety may also play a role. The severity of attacks will vary from episode to episode, as well as from patient to patient. Attacks typically last a few minutes.

Who Gets Raynaudís Disease?

Raynaudís disease occurs more frequently in women than in men. Although it can occur at any age it usually begins between the ages of 15 and 40. It is estimated that 4 - 5% of the United States population is affected.  Recently, a cluster has been documented in patients who have been exposed to toxigenic molds.  More studies are being conducted, but now researchers have discovered a definite link between the two.

How Is Raynaudís Categorized?

Raynaudís is divided into two categories.

Primary Raynaudís or Raynaudís disease, occurs when an individual has only the above mentioned color changes along with the typical symptoms of pain or numbness. There is no other medical problem which may be causing the Raynaudís episodes.

Secondary Raynaudís or Raynaudís phenomenon, occurs when the Raynaudís episodes are secondary to another medical condition. In other words, the individual with Raynaudís has another medical condition which is causing the attacks. Or, Raynaudís is only one of the symptoms associated with the other disease. Although this form is less common than primary Raynaudís, it is a more complex and serious disorder. Some examples of other underlying diseases associated with Raynaudís are: connective tissue diseases, scleroderma, rheumatoid arthritis, lupus, vibration white finger, occlusive arterial disease, thoracic outlet syndrome, carpel tunnel syndrome.

How Is Raynaudís Disease Diagnosed?

Primary Raynaudís disease is diagnosed following the Allen Brown criteria:

  • At least two of the three color changes occurring during attacks which are provoked by cold and or stress.                                                      

  • Episodes have been occurring periodically for at least two years. 

  • Attacks occurring in both hands.                                                           

  • There is no other identifiable cause for the Raynaudís episodes.

Additional testing which a physician might do to help with the diagnosis:

  • Antinuclear antibody blood test (usually negative in Raynaudís disease).

  • Examine the nail fold capillaries which should be in a normal pattern.

What Is The Treatment For Raynaudís Disease?

There is no known cure for this condition, therefore, effective treatments are essential. Most cases of primary Raynaudís can be controlled with proper medical care.

What you can do:

Many people are able to find relief by simply adjusting their lifestyle.  For example:

  • Protect yourself from the cold.
  • Avoid excessive emotional stress.
  • Do not use vibrating tools.

What a doctor might do:

For more severe cases that require medication, your doctor might prescribe drugs which keep your blood vessels from narrowing and help them dilate (expand), such as nifedipine, diltiazem, or nitroglycerin. Some of these medications may have side effects which you should discuss with your physician before taking.

If linked to fungal exposure, an IgG Panel should be conducted to determine fungal antibodies, then, if testing is positive to high positive, a course of anti-fungals and cholestyramine should also be prescribed in addition to above treatment to arrest further fungal growth.

Non-medication treatment:

Biofeedback has been demonstrated to be safe and effective for some individuals. This is a technique designed to help a person gain control over involuntary body functions, such as skin temperature, heart rate, or blood pressure. Biofeedback training is necessary and several methods are available.

Surgery:

In rare instances, a sympathectomy may be performed. This operation cuts the nerves that may also be affecting the blood vessels to the fingers. This procedure is usually not necessary and may only work for a short period of time.

 

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